MEDICARE: NANCY JANIK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB06477700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548249949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JANIK D.O.

Provider Business Mailing Address
First Line	:	19 W MAIN ST
Second Line	:	SUITE C
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7386
Fax Number	:	856-779-7563

Provider Business Practice Location Address
First Line	:	19 W MAIN ST
Second Line	:	SUITE C
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7386
Fax Number	:	856-779-7563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	10/16/2020

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